Request for E-Net User Name & Password

Please fill out all of the information requested below for a copy of your E-Net User Name and Password. Please allow 3-5 business days for processing.

Date:

Full Name :

Student ID#:

Alternate E-mail Address :

Cohort:

Student's Current Address (Be Sure to include apartment #s):

Student's Daytime Telephone #:

Student's Evening Telephone #:

Cell Phone Telephone #:

Please Note: Information will be mailed to the Permanent Address and your alternate e-mail address on file with the Dean's Office.